Provider Demographics
NPI:1871907915
Name:PRECISION TOXICOLOGY, LLC
Entity type:Organization
Organization Name:PRECISION TOXICOLOGY, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MIGUEL
Authorized Official - Middle Name:
Authorized Official - Last Name:GALLEGO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:800-635-6901
Mailing Address - Street 1:6755 MIRA MESA BLVD STE 123-153
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92121-4392
Mailing Address - Country:US
Mailing Address - Phone:800-635-6901
Mailing Address - Fax:858-228-9909
Practice Address - Street 1:1500 W WASHINGTON ST STE 3
Practice Address - Street 2:
Practice Address - City:MARQUETTE
Practice Address - State:MI
Practice Address - Zip Code:49855-3196
Practice Address - Country:US
Practice Address - Phone:800-635-6901
Practice Address - Fax:858-228-9909
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PRECISION TOXICOLOGY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-06-17
Last Update Date:2024-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACLF00343802291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory